Runners Gotta Run, right?

I know, I know… You are dying to hit the pavement, try out that new running stroller, get a good sweat on, feel like yourself again… But how do you know when you are ready after having your baby? Well, you won’t like this answer because the answer is… It just depends! Everyone is different. Everyone’s birth experience is different. For some it will be a few months, for others it may be a year. For runners, experts advise to wait until at least 3 months, perhaps even 6 months. Ya, it’s true…

THREE-TO-SIX MONTHS! Because so much healing is still going on.

So. Much. Healing.

It feels so great to move, stretch, get your heart rate up again, and it’s recommended by the experts to do so, but the best way to do this in the first 6 weeks (Evenson et al, 2014) is through walking, low-impact yoga, stretching, breathing…Lots of breathing. Nice big, full diaphragmatic and pelvic floor moving breaths. At 4TFM, we know that what we teach in PPR are movement patterns that can and should be started even in the first few days of your postpartum experience. (We share some great ideas in the first 10 days blog post) But I know, I know…What you want to know is “what does that have to do with running again”? Well, everything!

Your pelvic floor stretched to almost 250% to allow your baby to birth.

Let me just say that again.
Two Hundred and Fifty Percent!

Let’s Stop and have a moment to soak that in and give your sweet PF some appreciation. Really, she’s like the long-suffering best friend that you’ve had since forever. You know, the one that always has your back…And, in this case, she definitely tries to have your pelvic organs, too.

So… back to the Two Hundred and Fifty Percent (Svabik, 2009. Dietz, 2005). When you stop for a moment of shock and awe, is it any wonder that it takes about 4-6 months (Stær-Jensen et al, 2015) for your pelvic floor to recover… And, for some you sweet mommas, that’s gonna be up to a year because sometimes that perineum takes a major hit when baby is on the way out.

Oh, the questions!! The Questions!!

Let me tell you that you are not alone! I know that you are already asking (because all of the following are REAL questions that I have received!! Really!):

So… WHEN CAN I RUN? What about right after I’ve had a baby? I’m a marathoner and I was wondering if I can run the Boston in 3 months… When can I start to run again?

(No, really, that is a real question and I stand in amazement because I - a rather reluctant-but-wannabe runner - struggle to run a mile. On the treadmill. With Netflix. Ice cold water bottle by my side. And the AC on 68 degrees. But I am veering off topic.)

Back to the common and-I-swear-they-are-real questions…

What about the jogging stroller? Which jogging stroller? Can my baby run with me? What about my baby’s head bobbling? What if I pee in my pants? What if my uterus falls out?!! I am kind of worried about a prolapse. How do I get started? Will it take the baby weight off? I mean, I’m just being honest, that would be cool with me… Maybe I need a pessary? What about those vaginal weight things, would they help me heal faster? Will my boobs leak? Will running or exercise dry up my milk? Do you have a recommendation for a running bra? I heard that I should just wear 2 bras. My body doesn't feel the same, I am not sure that I am ready yet…How do I know if I am okay to start running?

I have heard every single one of those questions and so many more cuz, well…Runners gotta run, right?

These questions are so common that there are actually Returning to Running guidelines that were developed by very smart and amazing physical therapists who actually specialize in postpartum running. Cool job, right? And, because they are so smart, we - at 4TFM - knew that we should add many of the recommended running readiness exercises to our Postpartum Recovery Fitness (PPR) series. We use very specific cueing language that will fire the deep core and pelvic floor muscles to help stabilize and support your body so that you actually know what you should be doing.

In the meantime, here are a few things that you can do.

Remember that “Hugging Baby High and Dry” (HBHD) party trick you learned in Birth Ball Basics? Those same muscle groups that you used to HBHD while pregnant, will fire in the postpartum period to begin to strengthen your pelvic floor and stabilize your core while bridging the gap of your Diastasis Rect (DR). By the way, don’t be afraid of having a DR. That Diastasis is a NORMAL physiological change during pregnancy to make room for your growing uterus. NORMAL! But, it takes time for the abdominal muscles and fascial tension to heal and provide support again. Begin HBHD immediately, even the day after you have your baby, to start that healing. Be patient, though. Your mind will send the message but your body may take some time to connect.

Mind Body Connections

So - when can you get back to running? There are some recommended strengthening exercises to do in preparation. We are pretty excited to share some of them with you right here. The great thing is that these exercises are completely safe for super early postpartum runners - and non-runners, alike - and they will help you get back to doing what you love as soon as your body says, “Grab your sneakers, I am ready!”.

But be warned. Some of them “look” easy but aren’t!

Check out Running Readiness 102 for more on the exercises!

How will you know that you are ready?

Well... It depends…Everyone is different but here are some basics guidelines to help you know when you are ready and how to get to the place where you feel ready.

Blue and Yellow Scribble Father's Day Instagram Post.jpg

If Yes, to any of them please seek out a qualified Pelvic Floor PT in your area.

If the answer is NO to all. Then, maybe you are ready to start back to running again.

Here are some tips and strategies for you:

Get a plan together. Start with short-term goals and build from there.
Consider a running coach or group in your area.
Build volume before intensity. Start off by walking. See what happens when you do sets of hops, then jogging in place. Increase intensity thoughfully.
Do you experience any of the checklist above? If yes, consider a Pelvic Floor PT and modify until you feel ready. If not, then progress.
Hydrate well. High impact exercise should not impact your milk supply.
Wear a very supportive Running Bra. Don’t be tempted to double up your bras – especially if you are breastfeeding. A bra without underwire is recommended.
Use shortened strides and be aware of your footfall pattern. It’s easier on the pelvic floor to land mid foot rather than with a heavy heel strike.
Be mindful of pelvic floor dysfunction.
Use a Running Stroller (note: recommendations for a baby in a running stroller is 6-9 months). Be aware of the way you run with the stroller. It’s recommended to run with both hands on the handle to stay aligned. If you run in an area with hills, consider a stroller with a running brake.

Getting back to doing what you love to do is as important for your physical and your mental health. How you return to running will look different for each and every one of you. Be Smart. Be Fit. Be well. In Mind. In Body. And In your Community.

References:

1) Evenson, K. R., Mottola, M. F., Owe, K. M., Rousham, E. K. and Brown, W. (2014) Summary of International Guidelines for Physical Activity Following Pregnancy Obstet Gynecol Surv. 69(7): 407–414.

2) Svabik K, Shek K, Dietz H. How much does the levator hiatus have to stretch during childbirth? BJOG. 2009;116:1657-1662

3) Dietz HP, Lanzarone V. Levator trauma after vaginal delivery. Obstet Gynecol 2005;106:707–12.

4) Stær-Jensen, J., Siafarikas, F., Hilde, G., Benth, J.Š., Bø, K. and Engh, M.E. (2015) Postpartum recovery of levator hiatus and bladder neck mobility in relation to pregnancy. Obstet Gynecol 125, 531–539.

5) Ceydeli, A., Rucinski, J. and Wise, L. (2005) Finding the best abdominal closure: an evidence-based review of the literature. Curr Surg 62, 220–5.

6) Benjamin, D.R., Frawley, H.C., Shields, N., van de Water, A.T.M. and Taylor, N.F. (2018) Relationship between diastasis rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review. Physiotherapy

7) Brækken, I. H., Majida, M., Ellström Engh, M. and Bø, K. (2015). Can Pelvic Floor Muscle Training Improve Sexual Function in Women with Pelvic Organ Prolapse? A Randomized Controlled Trial. The Journal of Sexual Medicine, 12(2), 470–480.

8) Cary, G.B. and Quinn, T.J. (2001) Exercise and lactation are they compatible? Can J App Physio 26, 55-75.

9) Goom, T, et al. Running to Running Postnatal Guideline. www.dugof.dk/siteassets/dokumenter/fagligt/kliniske-retningslinier/returning_to_running_postnatal_guideline_for_medical_health_and_fitness_professionals_managing_this_population.pdf.

Running Readiness 101 for Postpartum Moms